Respiratory

Question 1

4 most common drugs against TB

Answer 1

(Isoniazid) INH: primary drug used
rifampin
ethambutol
pyrazinamide

Question 2

Isoniazid MOA

Answer 2

Suppresses bacterial growth by inhibiting synthesis of mycolic acid, a component of the mycobacterial cell wall.
Metabolized in the liver through acetylation—watch for “slow acetylators”

Question 3

Isoniazid A/E and what to administer in high risk pt groups

Answer 3

Hepatotoxicity
Peripheral neuropathy
- Administer pyridoxine (Vitamin B6) daily in high risk groups (i.e., DM, ETOH abuse) or if patient develops neuropathy

Question 4

Rifampin MOA

Answer 4

MOA: inhibits bacterial DNA-dependent RNA polymerase -> results in suppression of RN synthesis and protein synthesis

Question 5

A/E of Rifampin

Answer 5

discoloration of bodily fluids

Question 6

2 Analogs of Rifampin (close chemical make-up with same MOA and A/E)

Answer 6

Rifapentine

Rifabutin

Question 7

Pyrazinamide (PZA) A/E

Answer 7

Non-gouty polyarthralgias – (pain in multiple joints)

Question 8

Ethanbutol A/E

Answer 8

Optic neuritis – blurred vision, constriction of visual fields, & disturbance of color discrimination (red-green color blindness).

Question 9

What is the most effective drug class for prevention / treatment of seasonal & perennial rhinitis - it reduces inflammation and edema

Answer 9

Intranasal Glucocorticoids (-sone)

Question 10

Difference between H1 and H2 blockers (antihistamine)

Answer 10

H1 blockers are the drugs to which most people are referring when they use the term antihistamine. H1 blockers prevent the harmful effects of histamine and are used to treat seasonal allergic rhinitis, anaphylaxis, reactions to insect bites, and so forth.
H2 blockers are used to treat gastric acid disorders

Question 11

When to take first generation antihistamines?

Answer 11

take at bedtime to avoid sedation

Question 12

How to recognize first generation anti-histamine?

Answer 12

-amine

Question 13

Common second generation anti-histamines?

Answer 13

Zyrtec, Claritin, Clarinex, Allegra

Question 14

What is major difference between first and second generation anti-histamines?

Answer 14

Second generation poorly cross the blood-brain barrier; have a low affinity for H1 receptors in the CNS therefore does not cause sedation

Question 15

Sympathomimetics (Decongestants) MOA

Answer 15

Reduce nasal congestion via activation of alpha1 adrenergic receptors on nasal blood vessels -> vasoconstriction

Question 16

A/E to decongestants?

Answer 16

Rebound congestion (topicals) used for more than 5 days
CNS stimulation (oral) – restlessness, anxiety, insomnia
CV effects (oral) – tachycardia, inc. BP

Question 17

Three classes of bronchodilators

Answer 17

beta2-adrenergic agonists
anticholinergics
xanthine derivatives

Question 18

Give two categories of beta2 agonists and common drugs in each

Answer 18

Short Acting Beta Agonists: Albuterol
(think -buterol) Levalbuterol
Pirbuterol
Metaproterenol
Long acting beta agonist: Arformoterol
(think -moterol) Formoterol
Salmeterol

Question 19

LABA are not used alone in management of asthma. What additional class is added to regime?

Answer 19

Inhaled Corticosteroids (-sone or -sonide)

Question 20

Anticholinergics MOA

Answer 20

Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways.
Anticholinergics bind to the ACh receptors, preventing ACh from binding.
Result: bronchoconstriction is prevented, airways dilate

Question 21

Xanthines MOA

Answer 21

Action: inhibits phophodiesterase, an enzyme responsible for breaking down cAMP. Because this enzyme is inhibited, more cAMP is available for bronchodilation.

Question 22

Common Xanthine drugs (THEO-DUR)

Answer 22

Theophylline / iv form - aminophylline

Question 23

First and late sign of toxicity in patients receiving xanthine drug

Answer 23

Early - Nausea

Late - Tremors, Dysrhythmia and Convulsions

Question 24

Leukotriene Receptor Antagonist MOA

Answer 24

Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body.
Leukotrienes cause inflammation, bronchoconstriction, and mucus production
By blocking those receptors, you block that cascade

Question 25

Leukotriene receptor antagonist suffix

Answer 25

-kast

Question 26

Mast Cell Stabilizers MOA

Answer 26

Stabilize mast cells, reducing the release of mast cell chemicals that cause bronchoconstriction, edema, and inflammation. Interrupts migration of eosinophils into site

Question 27

Common Mast Cell Stabilizer drug

Answer 27

Cromolyn

Question 28

Inhaled Corticosteroids (ICS) MOA

Answer 28

Work by suppressing inflammation
Decrease synthesis & release of inflammatory mediators including leukotrienes, histamine, prostaglandins
Decrease infiltration & activity of inflammatory cells including eosinophils, leukocytes
Decrease edema of the airway mucosa 2nd to a decrease in vascular permeability

Question 29

A/E of the -sone or -sonide drugs (ICS)

Answer 29

Oropharyngeal candidiasis

Dysphonia (hoarseness)

Question 30

Step-wise approach to asthma control

Answer 30

Step 1 Short-acting inhaled beta2 agonist as needed
Step 2 Preferred: low-dose inhaled corticosteroid (ICS).
-Alternative: cromolyn, nedocromil, leukotriene receptor antagonist (LTRA), or theophylline
Step 3 Low-dose ICS and long-acting beta2 agonist (LABA) or medium-dose ICS
-Alternative: low-dose ICS and either LTRA, theophylline, or zileuton
Step 4 Preferred: medium-dose ICS plus LABA
-Alternative: medium-dose ICS plus either LTRA, theophylline, or zileuton
Step 5 High-dose ICS and LABA, and consider omalizumab for patients with allergies
Step 6 High-dose ICS and LABA and oral corticosteroid, and consider omalizumab for patients with allergies

Question 31

Anticholinergic Agents (how to recognize) and contraindicated in which patient population

Answer 31

-tropium bromide / may increase intraocular pressure - glaucoma pt’s

Question 32

Expectorants MOA and common drug

Answer 32

remove viscid (sticky) secretions by reduction of the adhesiveness & surface tension.
Guaifenesin (aka musinex and robitussin)

Question 33

Antitussive MOA

Answer 33

Suppresses the cough reflex in the medulla

Question 34

Common opioid antitussive

Common non-opioid antitusive

Answer 34

Codeine

Dextromethorphan and Benzonatate

Question 35

Acetylcysteine is common drug found in which class; MOA

Answer 35

Mucolytic Agents; Action – works directly on mucus to reduce thickness & make secretions less tenacious.

Question 36

What drug is indicated for patient with acetaminophen overdose?

Answer 36

Acetylcysteine

Question 37

Pulmonary arterial hypertension pathophysiology

Answer 37

Pulmonary hypertension is a type of high blood pressure that affects the arteries in the lungs and the right side of the heart.
Pulmonary hypertension begins when tiny arteries in lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through the lungs, and raises pressure within the lungs’ arteries. As the pressure builds, your heart’s lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and eventually fail.

Question 38

3 drug classes indicated for pulmonary hypertension

Answer 38

Prostacyclin Analogs
Endothelian 1 receptor antagonist
Phosphodiesterase Type 5 Inhibitors (-afil)

Question 39

Lung surfactant: Porcine extract of lung surfactant given to neonates w/ respiratory distress syndrome (how to recognize drug)

Answer 39

-actant